MX2007006100A

MX2007006100A - Minimally invasive spinal disc stabilizer and insertion tool.

Info

Publication number: MX2007006100A
Application number: MX2007006100A
Authority: MX
Inventors: Gary A Schneiderman; Bradley J Glenn
Original assignee: Bradley J Glenn
Priority date: 2004-11-23
Filing date: 2005-11-23
Publication date: 2007-07-19
Also published as: EP1814498A2; AU2005309438A1; WO2006058281A3; BRPI0518488A2; JP2008520400A; US20070299521A1; CA2586594A1; WO2006058281A2; US7887589B2

Abstract

The application relates to a spinal implant to be inserted between two vertebrato support and stabilize adjacent vertebra and allow for physiological motion.It includes an implantable device (200) to support the vertebrae, and a minimallyinvasive method for inserting and deploying the device within the intervertebralspace.

Description

MINIMALLY INVASIVE VERTEBRAL DISK STABILIZER AND INSERTION TOOL DESCRIPTION OF THE INVENTION The present invention relates generally to the field of the vertebral implants and, more particularly, to an implant that is configured to be placed within an intervertebral space to support and stabilize the adjacent vertebra and allow physiological mobility. The spine is the e e of the skeleton in which a substantial portion of the body's weight is supported. In humans, the normal column has seven cervical segments, twelve thoracic and five lumbar. The lumbar spine sits on the sacrum, which then joins the pelvis, and in turn is supported by the hip and leg bones. The vertebral bony bodies of the spine are separated by intervertebral discs, which act as joints, but allow known degrees of flexion, extension, lateral bending, and axial rotation. The typical vertebra has a thick anterior bone mass called the vertebral body, with a nervous (vertebral) arch arising from the posterior surface of the vertebral body. The spaces between the adjacent vertebrae are supported by intervertebral discs. Each nerve arch is combined with the posterior surface of the vertebral body and It encloses a vertebral orifice. The vertebral conformation of the adjacent vertebrae is aligned to form a vertebral canal, through which passes the sacrum, marrow, and small spinal nerve roots. The portion of the nerve arch that extends posteriorly and acts to protect the posterior side of the spinal cord is known as the lamina. The projection of the posterior region of the nervous arch is the spinous process. The primary intervertebral disc serves as a mechanical cushion that allows controlled activity between the vertebral segments of the axial skeleton. The disc is a unique structure that is comprised of three component tissues: the nucleus pulposus (nucleus) the annulus fibrosis "ring" and two vertebral end caps. The two vertebral end caps are composed of thin cartilage that underlies a thin layer of hard, cortical bone, which attaches to the spongy, richly vascular, porous bone of the vertebral body. The end coatings in this manner act to join the vertebrae adjacent to the disc. In other words, a transition zone is created by the end claddings between the malleable discs and the bony vertebrae. The disk ring is an external, rigid fibrous ring that joins together with the adjacent vertebrae. The stringy portion, which looks a lot like a tire Laminated automobile, measures approximately 10 to 15 millimeters in height and approximately 15 to 20 millimeters in thickness. The ring fibers consist of fifteen to twenty overlapping multiple layers, and they are inserted into the upper and lower vertebral bodies roughly at an angle of 40 degrees in both directions. This configuration particularly resists torsion, since approximately half of the angled fibers will be tensed when the vertebra rotates in any direction, relative to each other. The laminated layers bind less firmly to each other. The nucleus is located inside the ring. The healthy core is mostly a gel-like substance that has a high water content and, like air in a tire, serves to keep the taut ring still flexible. The core gel moves slightly inside the ring when force is exerted on the adjacent vertebrae while there is bending, elevation and other mobilities. The spinal disc can be displaced or damaged due to trauma, illness, degenerative defects, or use over a prolonged period of time. A herniated disc occurs when the fibers of the ring weaken or tear and the internal tissue of the nucleus becomes permanently bulging, distended, or expelled from its normal internal annular confines. The mass of a herniated or "slipped" nuclear tissue can compress a spinal nerve, which results in leg pain, loss of muscle control or even paralysis. Alternatively, with the degeneration of a disc, the core loses its ability to bind to water and deflates, as if the air were allowed to leave a tire. Subsequently, the height of the core decreases causing the ring to collapse in areas where the laminated layers loosely bond. As these superposed laminated layers of the ring begin to collapse and separate, annular, circumferential or radial tears may occur, which may contribute to persistent or disabling back pain. The junctions of the adjacent auxiliary vertebral facets will also be forced into an overload position, which can create additional back pain. The back pain related to the damaged or displaced intervertebral disc mentioned above is a very common health problem that affects most people at some point in their lives. The current treatment for back pain without sciatica is conservative care. However, when this fails, fusion of the vertebral segment is the most common practice. The intervertebral disc is removed, and the vertebrae are supported by the placement of several implants that help to promote the fusion of the adjacent vertebrae. While this treatment relieves pain, all the mobility of the discs it is lost in the merged segment. Ultimately, this procedure places a greater stress on the discs adjacent to the fused segment as they compensate for the loss of mobility, possibly leading to the premature degeneration of those adjacent discs. Spine surgeons recognize that it may be preferable to maintain the physiological mobility of the vertebral segment. Consequently, as an alternative to spinal fusion, a series of implants that has been designed to act as an artificial disc could retain mobility. The first implants or prosthetic discs incorporate a wide variety of concepts, such as ball carriers, springs, metal studs and other considered supports. All these prosthetic devices are manufactured to replace the entire intervertebral disc space and are large and rigid. Beyond the questionable applicability of the devices are the inherent difficulties encountered during implantation. Due to their size and inflexibility, these devices require a strategy of previous implantation, since the barriers presented by the lamina and, more importantly, the spinal cord and small nerve roots during posterior or posterior lateral implantation are difficult to avoid. . The previous implantation, however, can involve numerous risks during surgery. Several organs present physical obstacles as the surgeon tries to access the damaged disc area from the front of the patient. After an incision in the patient's abdomen, the surgeon is forced to navigate around interfering organs and move them carefully to the side in order to gain access to the spine. A risk to the patient of a previous strategy is that these organs can be damaged inadvertently during the procedure. Currently, as a result of the limitations of the available implants, and the difficulty and complications related to the surgical implantation of the current devices, their use has been limited. In contrast, a subsequent strategy for the implantation of the intervertebral disc avoids the risks of damaging bodily organs. Despite this advantage, a subsequent strategy also gives rise to other difficulties that have discouraged its use. For example, a later strategy may introduce a risk of damaging the spinal cord. Additionally, the geometry of the vertebral body allows only limited access to the intervertebral discs. In this way, the key to successful posterior or posterior lateral implantation is to avoid contact with the spinal cord and nerves, as well as being able to place an implant through a limited area due to the shape of the vertebral bones. Since a previous strategy does not present the limitations of space that occur with a posterior strategy, the current prosthetic disc designs are very bulky to be used safely with a posterior strategy. Therefore, there is a substantial need for a discrete prosthetic vertebral disc capable of being implanted in an intervertebral space, and a method for surgically implanting the discrete prosthetic vertebral disc into the intervertebral disc space through a subsequent strategy with minimal contact with the vertebral disc. the spinal cord and nerves and minimal damage to the surrounding soft tissue. There are two general strategies for an artificial disc: one is a complete replacement of the entire joint, where an articulated prosthesis is solidly attached to the adjacent vertebra. A second strategy is to replace only the "core" of the disc center with an implant that provides accommodating support in the center of the disc space but retains the natural support of the fibrous annulus and the supporting ligaments. The present invention adopts the advantages of both strategies, providing a minimally invasive support device in the center of the disc, while distributing the axial load to the robust peripheral cortical bone of the vertebrae. Also, the device maintains most of the ring, since only one is required small entry for insertion. The device also allows physiological mobility between the vertebral bodies. In one aspect, the invention relates to an intervertebral implant including an upper assembly having at least two elongated elements and a lower assembly having at least two elongated elements. Alternatively, the upper assembly or the lower assembly may have only a single elongated element or coating. The upper assembly is adapted to articulate relative to the lower assembly. In another aspect, the invention relates to an intervertebral implant that includes an upper assembly having at least one elongate member and a lower assembly having at least one elongated element interlocked with the upper assembly. The upper assembly can be adapted to allow a limited range of mobility between the intertwined elements, for example rotational mobility. In various embodiments of the above aspects, at least the two elongated elements of at least one of the upper assembly and the lower assembly were formed to form various configurations, such as, for example, A, H, I, K, M, N, T, V, W, X, Y and Z. At least one of the elongated elements may include a fold. In a In this modality, the intertrabbed elongated elements can define a space between them to allow a limited margin of mobility between the elements in an intertrained arrangement. At least the two elongate elements of at least one of the upper assembly and the lower assembly can be deployed between a closed position and an open position. The deployment can be effected either manually or automatically by, for example, a material with shaping memory, springs and / or other mechanical means. In one embodiment, at least the two elongated elements form an I-configuration, or another discrete configuration, in the closed position. In some embodiments, at least the two elongated elements form any of the configurations mentioned above when in the open position. Additionally, at least the two elongate elements can be positioned through a predetermined angular range between the closed position and the open position. In various embodiments, the predetermined angular range comprises a value greater than about 0 degrees and less than about 180 degrees. At least the two elongated elements can be secured by, for example, a pivot or similar connection. In several embodiments, the implant further includes a closing mechanism to prevent relative movement between the elongated elements. He The closing mechanism can be activated manually or automatically, by, for example, a material with shaping memory, springs, screws, bolts, couplings and / or other mechanical means. In various embodiments, the implant or components thereof may be fabricated from any biocompatible material, such as, for example, stainless steel, aluminum, tantalum, gold, titanium, ceramics, chromium, cobalt, nitol, metal / ceramic matrices, polytetrafluoroethylene ( PTFE), thermoplastic polyurethane (TPU); ethylenevimel acetate (EVA); thermoplastic polyether block amides; thermoplastic polyester elastomers, nylon, silicones, polyethylenes; polyamides; polyetheretherketone (PEEK); and combinations thereof. Additionally, at least one of the upper assembly and the lower assembly can be adapted to engage an adjacent vertebral surface. For example, the assemblies may include projections to engage the bone or openings therein to allow bone growth. Additionally, the implant may be coated or otherwise treated with, for example, a biological or therapeutic agent. In some embodiments, the implant includes a hinge region disposed in each of the upper assembly and lower assembly. The articulation regions may include a protrusion arranged in one of the upper and lower assembly and a splice recess insulated in the other assembly, the protuberance and the hollow at least partially in contact. The articulation regions may be, for example, a patella configuration, a male-to-female configuration, arcuate splice surfaces, or corresponding mounts. In one embodiment, at least one of the elongated elements tapers along a length thereof. The implant may include a spacer disposed between the upper assembly and the lower assembly. Additionally, the articulation region may be expandable to increase the overall carrying surface between the upper and lower assemblies. In another aspect, the invention relates to an intervertebral implant including a first elongate element having a first surface and a second opposing surface and a second elongate element having a first surface and a second opposing surface. The first surfaces are substantially flat. The second surfaces include complementary splice joint regions to allow relative movement of the first elongate element and the second elongate element. In one embodiment, the articulation regions are arranged close to a midpoint on each second surface. In several embodiments, the first elongate element is oriented substantially parallel to the second element elongate. The first surface of at least one of the first element and the second element is adapted to engage an adjacent vertebral surface. The regions of articulation of the implant may include a protrusion disposed in one of the elongated elements and a splice recess disposed in the other elongate member. The protuberance and hollow at least partially in contact. The complementary splice regions may, for example, be a pin configuration, a male-to-female configuration, arcuate splice surfaces, or corresponding frames. The implant may include a spacer disposed between the second surfaces of the first elongate member and the second elongate member, the spacer replicates the regions of the joint. The second surfaces of the first element and the second element can taper along a length thereof. The implant may include at least one opening to allow bone growth therein. Additionally, the implant may include a third elongate element that includes a first substantially planar surface and a second opposing surface defining a notch, wherein the notch engages the first surface of the first elongate member. In one embodiment, the notch bisects the third elongated element. He The third element can be disposed above and substantially perpendicular to the first elongate element. In addition, the implant may include a fourth elongate element that includes a first substantially planar surface and a second opposing surface defining a notch, wherein the notch of the fourth elongate member engages the second elongate member. In one embodiment, the notch defined by the fourth elongated element bisects the fourth elongated element. The fourth element can be arranged below and substantially perpendicular to the second elongate element. In one embodiment, the first elongated member and the second elongate member each define a notch disposed in the first surfaces thereof. The notch of the first element is connected to the notch of the third element and the notch of the second element is connected to the notch of the fourth elongate element. The first surfaces of at least one of the first and third elongated elements and the second and fourth elongated elements are substantially coplanar. The notches may include arcuate and / or tapered side walls to provide space between the elongated elements for relative rotational movement between the elongated elements. In another aspect, the invention relates to an intervertebral implant including a first elongate element having an elastic body adapted to contact a vertebral surface proximal in at least two contact regions, and a second elongate element having an elastic body adapted to contact a proximal vertebral surface in at least two contact regions. The first and second elongate elements include articulation regions disposed along their respective resilient bodies between the contact regions. The first elongated element and the second elongate element can be joined by the articulation regions. In various embodiments of the above aspect, at least one of the elastic bodies includes an arched configuration. The first elongate element can be oriented substantially perpendicular to the second elongate element. In one embodiment, the articulation regions are disposed within the notches formed in the first and second elongate elements. In another aspect, the invention relates to an intervertebral implant that includes a first elongate element and a second elongate element. The first elongate member includes a first base liner for engaging an adjacent vertebral surface and a first elastic liner coupled to the first base liner. The second elongate member includes a second base liner for engaging an adjacent vertebral surface and a second elastic liner coupled to the second base covering. The first elastic coating and the second elastic coating are adapted to be joined together to allow relative movement between the first elongate element and the second elongate element. In one embodiment, the elastic coatings are not flat. The coatings may each have an elongated configuration. The first elastic coating is coupled to the first base coating at the ends thereof, and the second elastic coating is coupled to the second base coating at the ends thereof. The first and second elastic coatings can define grooves in the external surfaces thereof to inter-engage. In another aspect, the invention relates to an intervertebral implant that includes a first element and a second element. The first element includes a proximal portion and a distal portion, each extending from a central portion of the first element. The proximal portion and the distal portion extend in opposite directions and slide relative to a longitudinal e of the first element. The second element includes a proximal portion and a distal portion, each extending from a central portion of the second element. The proximal portion and the distal portion extend in opposite directions and slide relative to a longitudinal e of the second element. He The first element includes a first articulation region disposed on a first surface of the central portion of the first element, and the second element includes a second articulation region disposed on a first surface of the central portion of the second element adapted to be connected with the first region. of articulation. The first and second articulation regions are at least partially in contact to allow relative movement between the first element and the second element. In various embodiments, the longitudinal axes bisect the central portions of the first and second members and the corresponding proximal and distant portions are evenly spaced around their respective longitudinal axes. The implant may further include a third element that includes a proximal portion and a distal portion, each extending from a central portion of the third member. The proximal portion and the distal portion extend in opposite directions and slide relative to a longitudinal axis of the third element. The proximal and distant portions of the third element are oriented in a favorable manner to the proximal and remote portions of the first element. The third element is connected to a second opposite surface of the first element. The central portions of the first element and the third element have reduced thicknesses in relation to the portions next and distant from the first and third elements, such that a first surface of the third element is substantially coplanar with the second surface of the first element when they are spliced. Additionally, the implant may further include a fourth element that includes a proximal portion and a distal portion, each extending from a central portion of the fourth member. The proximal portion and the distal portion extend in opposite directions and slide relative to a longitudinal axis of the fourth element. The proximal and distant portions of the fourth element are oriented favorably to the proximal and distant portions of the second element. The fourth element is connected to a second opposite surface of the second element. The central portions of the second element and the fourth element have reduced thicknesses relative to the proximal and distal portions of the second and fourth elements, such that a first surface of the fourth element is substantially coplanar with the second surface of the second element when they are spliced . In addition, the third element can be secured to the first element and the fourth element can be secured to the second element by pivot joints. At least a portion of the first surfaces of the third and fourth elements can be adapted to merge with a surface vertebral The implant may include a closing mechanism to prevent relative movement between the first element and the second element. The first element and the second element are capable of relative rotational movement and the closing mechanism is capable of closing the first element at an angle of rotation relative to the second element. The angle of rotation can be from about 0 degrees to about 90 degrees. In another aspect, the invention relates to a tool for deploying an intervertebral implant. The tool includes a first body adapted to be coupled to a first portion of the implant and a second body adapted to engage a second portion of the implant. The second body slidably engages the first body. The first body and second body can be slidably coupled by a tongue and groove joint. The second body may include a proximal end configured as a wedge. The tool may include a handle extending from the first body. In various embodiments, a distal end of the second body is coupled to the implant when the implant is placed. The second body adapted to uncouple from the first body to orient the proximal end in contact with the implant to deploy the implant. Deploying the implant may include moving the configured proximal end in wedge between the first portion and the second portion of the implant to move the second portion beyond the first portion of the implant. The first portion of the implant and the second portion of the implant can be rotatably coupled to allow relative rotational movement of the second portion relative to the first portion of the implant. In another aspect, the invention relates to a tool for deploying an intervertebral implant. . The tool includes an elongate body adapted to engage a portion of the implant and a handle extending therefrom. The elongated body has a wedge-shaped projection extending from a distal portion of the elongated body. The distal portion of the tool can be spliced with the implant. The tool displaces a first portion of the implant relative to a second portion of the implant in the rotation of the tool. In another aspect, the invention relates to a method for installing an intervertebral implant, the method includes the steps of providing a spinal vertebral implant, coupling the intervertebral implant to a tool, and implanting the implant in a body relative to two adjacent vertebrae. The implant has two portions with relative movement capability, and the tool has a first body adapted to be coupled to a first portion of the implant and a second body adapted to engage a second portion of the implant. The second body slidably engages the first body and has a proximal end configured as a wedge. The method also includes the steps of decoupling the second body from the tool; reorienting and re-coupling the second body to the tool, such that the proximal end configured in wedge contacts at least a portion of the implant; and moving the second body towards the implant to separate the first portion of the second portion. Alternatively, the method can be carried out with the use of a cannula, where an implant is coupled to a tool and implant and tool are passed through the cannula, inserted inside the body to facilitate the insertion of the implant into the space intervertebral An elongated tool with a wedge, or other appropriately configured tool, may be passed along the cannula to separate the first portion of the implant from the second portion of the implant. In several embodiments, the method also includes the step of decoupling the implant tool. In one embodiment, the implantation step is performed at least once laterally, posteriorly laterally and anteriorly laterally. The first portion of the implant can be rotatably coupled to the second portion of the implant to allow relative rotational movement. The method can further include the step of closing the first portion of the implant at an angle relative to the second portion of the implant. In another aspect, the invention relates to an intervertebral implant including an upper assembly defining a first vertebral contact surface and a lower assembly defining a second vertebral contact surface, and adapted to articulate relative to the upper assembly. At least one of the first vertebral contact surface and the second vertebral contact surface comprise an expandable surface area. In another aspect, the invention relates to an intervertebral implant that includes an upper assembly and a lower assembly that supports the upper assembly and is adapted to articulate relative to the upper assembly. At least one of the upper assembly and the lower assembly is configured to include an expanded vertebral contact surface area. In another aspect, the invention relates to an intervertebral implant including an upper assembly having at least two elements, at least the two configurable elements for varying a size of a vertebral contact surface area of the upper assembly, and a lower assembly that supports the upper assembly, the The lower assembly comprises at least two elements, at least the two configurable elements for varying a size of a vertebral contact surface of the lower assembly. In another aspect, the invention relates to an intervertebral implant that includes an upper assembly and a lower assembly coupled to the upper assembly through splice joint regions. The articulation regions comprise expandable carrying surfaces. These and other objects, together with advantages and features of the present invention described herein, will become apparent through reference to the following description, the accompanying drawings and the claims. Furthermore, it is understood that the features of the various embodiments described herein are not mutually exclusive and may exist in various combinations and permutations. BRIEF DESCRIPTION OF THE DRAWINGS In the drawings, similar reference characters generally refer to the same parts in all the different views. Also, the drawings are not necessarily to adapt, the emphasis is usually placed on illustrating the principles of the invention. In the following description, various embodiments of the present invention are described with reference to the following drawings, in which: Figure 1 is a schematic perspective view of an intervertebral implant with two parallel elongated elements, according to one embodiment of the invention; Figure 2 is a schematic side view of an alternative intervertebral implant with two parallel elongate elements with a spaced apart spacer, according to one embodiment of the invention; Figure 3 is a schematic side view of the intervertebral implant of Figure 1 inserted between two vertebrae, according to one embodiment of the invention; Figure 4A is a schematic top view of the intervertebral implant of Figure 1 inserted into an intervertebral space by a lateral posterior strategy, according to one embodiment of the invention; Figure 4B is a schematic end view of the insertion tool shown in Figure 4A, according to one embodiment of the invention; Figure 5 is a schematic top view of the intervertebral implant of Figure 1 inserted into an intervertebral space by a lateral strategy, according to one embodiment of the invention; Figure 6A is a schematic perspective view of two outer segments of a cross-sectional medvertebral implant, in accordance with one embodiment of the invention; Figure 6B is a schematic perspective view of two internal segments of an intervertebral implant of transverse configuration, according to one embodiment of the invention, Figure 7 is a schematic perspective view of an intervertebral implant of transverse configuration assembled, in accordance with one embodiment of the invention; Figure 8 is a schematic side view of the intervertebral implant of Figure 7 inserted between two vertebrae, Figure 9 is a schematic top view of the intervertebral implant of Figure 7 inserted into an intervertebral space; Figure 10 is a schematic top view of an alternative intervertebral implant, consisting of two transverse elements, inserted into an intervertebral space, according to one embodiment of the invention; Figure 11 is a schematic perspective view of the intervertebral implant of Figure 10; Figure 12 is a schematic side view of a "leaf spring" element of an intervertebral implant, according to one embodiment of the invention; Figure 13 is a schematic perspective view of an arched element of an implant intervertebral, according to one embodiment of the invention; Figure 14 is a schematic side view of two arcuate elements inserted between two vertebrae in a transverse configuration; Figure 15 is a schematic top view of the configuration of Figure 14; Figure 16 is a schematic side view of an intervertebral implant comprising two parallel arcuate elements, according to one embodiment of the invention; Figure 17A is a schematic top view of a two-component "scissors" element of an intervertebral implant in a closed configuration, according to one embodiment of the invention; Figure 17B is a schematic top view of the "scissors" element of Figure 17A in an open configuration; Figure 18 is a schematic side view of a four-segment "scissors" intervertebral implant in a closed configuration, according to one embodiment of the invention; Figure 19 is a schematic top view of the closed four-segment "scissors" intervertebral implant of Figure 18; Figure 20 is a schematic side view of an intervertebral "scissors" implant of four segments in an open configuration, according to one embodiment of the invention; Figure 21 is a schematic top view of the open four-segment "scissor" intervertebral implant of Figure 20; Figure 22 is a schematic side view of a four-segment "scissor" intervertebral implant articulating about its central axis, according to one embodiment of the invention; Figure 23 is a schematic top view of a four-segment "scissors" intervertebral implant mounted on an insertion tool, according to one embodiment of the invention; Figure 24 is a schematic left side view of the intervertebral implant and insertion tool of Figure 23; Figure 25 is a schematic right side view of the intervertebral implant and insertion tool of Figure 23; Figure 26 is a schematic end view of the insertion tool of Figure 23; Figure 27 is a schematic top view of a four-segment "scissor" intervertebral implant mounted on an insertion tool with all the insert screws in place, in accordance with a embodiment of the invention; Figure 28 is a schematic top view of the intervertebral implant and insertion tool of Figure 27 with the right side attachment screws separated from the implant; Figure 29 is a schematic top view of the spinal implant and insertion tool of Figure 27 with the right side of the insertion tool removed; Figure 30 is a schematic top view of the intervertebral implant and insertion tool of Figure 27 with the right side of the insertion tool attached in a deployment configuration: Figure 31 is a schematic top view of the intervertebral implant and tool. insertion of Figure 27 with the right side of the insertion tool attached in deployment of the segments of the implant; Figure 32 is a schematic top view of the spinal and insertion implant of Figure 27 with the right side of the insertion tool removed and the implant in an open configuration; Figure 33 is a schematic top view of the open intervertebral implant and insertion tool of Figure 27 with the joint screws separated from the tool; Figure 34 is a schematic top view of the intervertebral implant of Figure 27 in the open and closed position with the insertion tool removed; Figure 35 is a schematic perspective view of the handle side of an insertion tool and the segments of an intervertebral implant type "Scissors" of four segments, according to one embodiment of the invention; Figure 36 is a schematic top view of an example of a four-segment "scissors" intervertebral implant, according to one embodiment of the invention; Figure 37 is a schematic side view of the intervertebral implant of Figure 36 attached to an alternative insertion tool, according to one embodiment of the invention; Figure 38 is a schematic top view of the intervertebral implant of Figure 36 and the insertion tool of Figure 37; Figure 39 is a schematic top view of the intervertebral implant and insertion tool of Figure 37 inserted through an insertion housing; Figure 40 is a schematic top view of the intervertebral implant and insertion tool inserted in the insertion housing of Figure 39; Figure 41 is a schematic top view of the configuration of Figure 40 with a distracting wedge deploying the implant; Figure 42A is a schematic top view of a two-segment "scissors" intervertebral implant configured for minimum transverse profile for insertion, according to one embodiment of the invention; Figure 42B is a schematic side view of the intervertebral implant of Figure 42A; Figure 43A is a schematic perspective view of a two-segment intervertebral implant and slotted insertion tool with a minimum transverse profile at the leading edge during insertion, according to one embodiment of the invention; Figure 43B is a schematic side view of the intervertebral implant of Figure 43A with a rotatable insertion tool; Figures 44A-44F are schematic top views of alternative implant assemblies, according to various embodiments of the invention; Figures 45A and 45B are schematic top views of an alternative implant assembly that includes an expandable contact surface, in accordance with one embodiment of the invention; Figures 46A and 46B are top views Schematic of another alternative implant assembly including an expandable contact surface, according to one embodiment of the invention; Figures 47A-47C are schematic top views of an alternative implant assembly including an expandable and movable splice joint, according to one embodiment of the invention; and Figures 48A and 48B are schematic top views of another alternative implant assembly that includes a movable splice joint, in accordance with one embodiment of the invention. The invention provides an apparatus for implantation between two vertebrae of a spinal column to replace or relieve tension in an intervertebral disc. The apparatus comprises at least one upper assembly and one lower assembly that can be articulated around a mechanical connection between the upper and lower assemblies, thereby allowing the controlled relative mobility of at least two assemblies. As a result, when placed between and joins or rests against two vertebrae, the implant allows controlled mobility between vertebral segments of the axial skeleton, similar to that provided by the intervertebral disc that is replaced or supported. The invention also provides a method and apparatus for implanting the device inside the intervertebral space. The method employs a minimally invasive or open lateral, anterior lateral, or posterior lateral strategy that minimizes damage to the soft tissues around the implant. The apparatus for inserting the implant can be used to insert the implant and deploy the implant in an operating configuration within the intervertebral space. Figure 1 is a schematic perspective view of an intervertebral implant with two separate parallel elongated elements. The implant 10 includes an elongate top element 12 and a bottom elongate element 14 which contact each other through a splice joint region generally located around a central region of each element. In this configuration, the splice joint region includes complementary portions in the upper elongate element 12 and the lower elongate element 14, such that the convex or male splice joint region 18 in the upper elongate element 12 is spliced with a concave or female joint articulation region 20 in the lower elongated element 14. The elongated upper element 12 and the lower elongated element 14 have a substantially rectangular profile with 90-degree edges substantially straight In alternative embodiments, the elongated elements may form oblong, elliptical or other appropriately shaped profiles, while the edges of the elongated elements may be rounded, curved, chamfered or otherwise configured to allow easier insertion into, and better and safer use. inside, of the intervertebral space. The splice joint regions are designed to allow relative mobility between the upper elongated element 12 and the lower elongate element 14 such that the elements can be articulated, rotated, mounted or rotated about the center of the splice joint portion without no misalignment of the two elements. This articulation between the upper and lower elements of the implant device can allow the physiological mobility of the spine, such as flexion, extension, lateral bending and / or physiological translation. In some embodiments, the upper and lower portions of the splice joint can be adjusted together with a loose connection, allowing a certain amount of play between the two articulation portions. As a result, the upper elongated element 12 and the lower elongate element 14 can be free to articulate or rotate about the center of the joint joint. In certain alternative configurations, the upper portions and bottom of the joint joint can be adjusted comfortably together, either by connecting the two elements of the implant 10 together in a rigid position, or by limiting the available joint between the two elements by a predetermined amount. The splice joint may include, but is not limited to, a ball-and-socket connection, a protrusion and saddle joint connection, or another suitably appropriate one. The selection of an appropriate splice joint may allow the elements to rotate with each other only in one direction, for example along the length of the axis of the elongated elements, or to rotate in any direction about the central axis of the joint joint. The upper elongated element 12 and the lower elongate element 14 include a vertebral surface 26, which defines the external portion of the implant 10, which contacts the upper and lower vertebrae respectively, and a joint surface 28 on the internal portion of the implant The vertebral surface 26 of each element is substantially flat, while the articulating surface 28 of each element is beveled in such a way that each element is thinner at its ends and thicker towards its central region. This bevelling or tapering of the joint surfaces 28 of each element is allowed for a greater range of mobility since the elongate element 12 and the The lower elongated element 14 articulates or rotates relative to each other around the joint joint. Changing the angle of the bevel on each joint surface 28 may therefore change the range of mobility available for the implant 10. In alternative embodiments of the invention, the joint surfaces 28 may be of a different configuration, such as, but not limited to, , a flat or curved surface, depending on the required articulation of the implant 10. In certain embodiments, the configuration of the articular surface 28 of the upper elongated element 12 and the lower elongated element 14 may differ, while in additional embodiments, the configuration of the supeificie 28 articulate on each side of a single element may also differ. In some embodiments of the invention, the vertebral surfaces 26 of one or both of the implant elements 10 may also include a beveled and / or curved portion, depending on the specific requirements of the implant. The projections 16 may be joined or otherwise formed on the vertebral surfaces 26 of one or both of the elements of the implant 10. Allowing the vertebral surfaces 26 to better contact or attach to the vertebrae directly above and below the implant 10. The projections 16 may have several ways to interact in a way Secure with the vertebra. These shapes may include, but are not limited to, one or a plurality of nails, hooks or other raised elements for securely embedding in the vertebra. In alternative embodiments, the projections 16 may include nodular, grooved, scored or otherwise textupped regions of the vertebral surface to provide a more secure contact with the vertebra above and below the implant 10. In additional alternative embodiments, the projections 16 may be replaced by, or assisted by, an adhesive substance, such as, but not limited to, a biological adhesive, which can be placed in a region of the vertebral surface 26 and / or one or more sides, of one or more elongated elements to improve contact between the vertebra and the implant 10. The upper and lower elements of the implant may include, either in conjunction with or in place of the projections 16 and / or the adhesive described therein, a single or a plurality of patterns 22, such as as, but not limited to, holes, voids or other surface properties, along the vertebral surface 26 and the sides of each implant element 10. This Indentations can promote bone growth in the implant to fuse the implant to the vertebra. In alternative embodiments of the invention, the projections 16, adhesive and / or indentations 22 can only be placed in one of the upper and lower elements 12 of the implant 10. In certain embodiments, the indentations 22 can be placed only on certain surfaces of each element, such as, for example, only on the vertebral surfaces 26 of each elongated element. It should be noted that any combination of the above methods of improving contact between the implant 10 and the vertebrae can be placed on any of the external surfaces (i.e., the vertebral surfaces 26 and the sides, and the ends of each element 12, 14) , and it is not necessary to have the same combination of elements on either side. As such, different configurations of contact improvement methods can be employed on different surfaces, depending on the particular requirements of the implant 10 and the particular geometry and physiology of a patient's spine. In a further alternative embodiment, one or both of the elongated elements may be free of any projections 16, indentations 22, and / or adhesive, with the pressure of the vertebrae above and below the implant 10 keeping the implant 10 in place. In a further alternative embodiment, the separate closure elements can be deployed within the intervertebral space to secure the implant 10 to the vertebrae.

Additionally, the implant 10 may be coated or otherwise treated with biological or therapeutic agents to, for example, promote bone growth or treat infection. In further alternative embodiments, the implant may include a mechanism, such as, but not limited to, a cannula and micro-pump, to allow delivery of a biological or therapeutic agent to the spine of an internal or external storage reservoir. Figure 2 is a schematic side view of an alternative intervertebral implant 10 with two parallel elongated elements, with a separate spacer element 24 positioned between the concave or female splice joint regions 34, 36 in the upper elongated element 12 and the element 14 elongate bottom of the implant 10 respectively. Again, each element of the implant 10 includes a substantially planar vertebral surface 26 and a beveled joint surface 28. As described above, the configuration of the vertebral surfaces 26 and the articular surfaces 28 of each element can be changed in alternative embodiments of the invention to meet the specific requirements of a given implant 10. The elongated upper element 12 and the lower elongated element 14 can also, in certain embodiments, include projections 16, indentations 22, and / or adhesive substances on their vertebral surfaces 26 and / or sides for better connect the elements to the surrounding vertebrae. In alternative embodiments, the splice joint regions 34, 36 may include at least one, and possibly two, convex protrusions, with the corresponding spacer 24 including concave matching sides for splicing with the joint regions 34, 36 of the splines. elements 12, 14 upper and lower. The spacer element 24 allows the two elements to articulate or rotate with each other, as described in the foregoing. The spacer 24 can replicate the articulation regions and can be of ellipsoid or other favorable configuration suitable for splice joint regions 34, 36 such as, but not limited to, a ball, biconvex or biconcave shape. The spacer 24 can be constructed of the same material as the elongated elements of the implant 10, or constructed of a material different from the surrounding elongate elements. Using a different material for the spacer 24 can, for example, improve the life of the implant 10 or change the friction characteristics of the articulation region to facilitate or possibly prevent the relative mobility of the two elongated elements. Figure 3 is a schematic view of the intervertebral implant of Figure 1 inserted between two vertebrae. Each vertebra 30 is connected through a disk 32 intervertebral The implant 10 can be used to replace or support an intervertebral disc 32 between two vertebrae 30. As shown in Figure 3, the vertebral surfaces 26 of the upper elongated element 12 and the lower elongate element 14 rest against the surfaces of the surrounding vertebrae 30. . The implant 10 allows the upper 12 and lower elongate elements 14 to articulate relative to each other through the joint articulation region, thereby allowing the column to move and bend in a manner similar to the movement allowed by the intervertebral discs 32. healthy The implant 10 can be inserted into the intervertebral space in a number of ways, including, but not limited to, minimally invasive strategy or open lateral, anterior lateral or posterior lateral that minimizes damage to the soft tissues around the implant. Figures 4A and 5 show two possible methods for inserting the implant 10 between two vertebrae. Figure 4A is a schematic top view of the intervertebral implant 10 of Figure 1 inserted into an intervertebral space through a posterior lateral strategy. In this method, because of the small profile of the end of the implant 10, it can be inserted into the intervertebral space through a small incision in the back of the patient. The incision can be made in the back and to the side of the spine, for example at a 45-degree angle in the posterior front of the spine. In alternative modalities, this angle can be increased or decreased, depending on the physiology, size and configuration of the patient and the requirements of the implant 10 in the insertion. To facilitate insertion of the implant into the intervertebral space, a cannula 38, or other appropriate hollow tube, can be inserted into the incision made in the patient's back. The implant 10 can then be inserted through the hollow cannula 38 and into the intervertebral space without having to be forced through the intermediate tissue, etc. The insertion of the implant 10 may involve the use of an insertion tool to place the implant 10 in the appropriate location and deploy the implant 10 placed in its active position. For example, the implant 10 can be closed in a non-articulation configuration using an integrated closure mechanism or a separate closure element. In the insertion of the blank, this closing mechanism can be released by the insertion tool to allow relative articulation of the upper 12 and lower elongate elements 14. In alternative embodiments, standard surgical equipment can be used to insert the implant 10 into the space intervertebral, with or without the need for a cannula and / or closure mechanism. The cannula 38 can be a rigid or flexible tube that can be inserted into the patient through the incision to provide a path for the implant 10. In certain embodiments, this tube can be inserted into the body in its final form, while in other embodiments , the tube can be inserted into the body in a collapsed or partially collapsed form to minimize its insertion profile, and then expand to its final shape after insertion. The cannula 38 may be a cylindrical tube, square, rectangular or otherwise appropriately shaped or may be configured to complement the profile of the implant 10. In some embodiments of the invention, the cannula may have a completely enclosed cross section, while in other embodiments the cannula can be replaced by an insertion housing 39 that opens at least partially on one side, thereby forming a cross section configured norrnally at "C". The open portion of the insert housing 39 may, in some embodiments, provide a path that can be used to stabilize the implant during insertion, or to allow the body material to exit the canal while the implant 10 is inserted. An extreme view of an example insert housing 39 can be seen in Figure 4B, when a housing 39 of cross section nominally configured in "C" that provides a hollow central channel 41 for the passage of the implant 10, and a recess 43 that provides a path for the implant 10 and an escape means for any In addition, the cannula 38 or housing 39 may include geometry, such as a wedge configuration, at its proximal end inside the body to bypass the adjacent vertebrae or otherwise facilitate the insertion of the implant. Figure 5 is a schematic top view of the intervertebral implant 10 of Figure 1 inserted into an intervertebral space through a lateral strategy. In this method, an incision is made on the patient's side in a location that results in the implant 10 being inserted at a 90 degree angle to the posterior front axis of the spine. The implant 10 can then be inserted into the intervertebral space using any of the same apparatuses and methods described for the posterior lateral strategy of Figure 4A. Figure 6A is a schematic perspective view of two external segments of a transversely configured intervertebral implant. In this configuration, the implant 40 consists of four elongated elements that combine to produce an implant 40. configured as upper and lower transverse shaped elements that interact in a central junction articulation region. Figure 6A shows two external segments of the implant 40. Here, an upper secondary element 42 and a lower secondary element 44 are placed parallel to each other. The vertebral surfaces of the elements 42, 44 include protuberances 50 that can be used to more securely connect the implant 40 to the abutting vertebrae. These protuberances 50 can take any of the forms described for the embodiments of Figures 1-5. The elements 42, 44 may also include indentations and / or adhesive portions, again as described for the embodiments of Figures 1-5. The center of the articular surfaces of each of the elements 42, 44 includes notches 46, 48 respectively allowing the elements 42, 44 to interlock with optional, complementary notches in the transverse elements of the implant 40. These transverse elements can be seen in the Figure 6B. Here, an upper primary element 60 and a lower primary element 62 are placed parallel to each other, at 90 degrees to the upper and lower secondary elements 42, 44. The upper and lower primary elements 60, 62 include optional notches 64, 66, respectively, allowing the elements 60, 62 to interlock 90 degrees of the elements 42, 44 side ones shown in Figure 6A. The primary elements 60, 62 also include a splice joint region that allows the upper element 60 to be connected to the lower element 62 in an articulated or rotating manner. In the embodiment shown, the upper articulation element, attached to the upper element 60, comprises a convex protuberance 68 or male, while the lower articulation element, joined to the lower element 62, comprises a corresponding concave receptacle or female. As described in the foregoing for the embodiments of Figures 1-5, the splice joint region may include a number of possible arrangements, such as, but not limited to, a complementary male and female joint, two females, or a female and one male, or two male joints with a complementary spacer; a ball joint, a pair of frames; or any other appropriate splicing elements. As with the embodiments of Figures 1-5, the splice joint can, in certain embodiments, allow articulation or rotary mobility along only one elongated shaft, or in other embodiments, allow the implant 40 to rotate in any direction around the central ee of the joint joint. The elements 42, 44, 60, 62 are all tapered on their articulated surfaces to allow a margin Increased mobility while the implant 40 rotates or articulates. In certain embodiments, the tapered may be the same in each elongated element to allow the implant 40 to rotate equally in each direction. In other embodiments, each elongate element may have a different taper or configuration, to increase or decrease the angle at which the implant 40 may rotate in certain directions. For example, the range of mobility of the patient's spine is not necessarily the same in all directions, so by careful selection of the shape and taper of each elongated element, the range of mobility of two vertebrae with respect to each other can be matched in All directions Interlacing the primary element 60 and the upper secondary element 42 together and the primary element 62 and the lower secondary element 44 together at the locations of the notches in each element results in the assembled implant 40 shown in Figure 7. Construct a An implant forming a transverse configuration can increase the stability of the implant and allow the lower upper elements to rotate better in all directions. The transverse configuration also increases the surface area on which the vertebral surface of each element contacts the vertebra. This helps to spread the load between the implant and the associated vertebrae and can thus help avoid subsistence, where the implant sinks or integrates into the vertebrae over time, possibly damaging the vertebrae. An example of a transverse shaped implant inserted into a body can be seen in Figures 8 and 9. Figure 8 depicts a side view of the intervertebral implant 40 inserted in the spinal column between two vertebrae 30, such that it can replace or support a damaged spinal disc in that location. Figure 9 shows a top view of a cross-shaped intervertebral implant 40 positioned between two vertebrae 30. While in some embodiments of the invention, the transverse elements of the implant may be 90 degrees from each other, in other embodiments, such as in the implant of Figure 9, the angle between the crossing elements can be less than 90 degrees. Implants with different transverse angles can be used depending on factors such as the geometry and size of the vertebrae that are supported and the physiology of the patient. Due to the larger profile of the transverse shaped implant 40, a larger incision may be necessary in the patient to insert the implant 40 into the intervertebral space. This can be reduced, however, by using an implant that can be inserted into the body in a folded or collapsed configuration to minimize its cross-sectional profile, after which the implant deploys in a transverse configuration within the intervertebral space. Alternatively, the secondary segments 42, 44 can be inserted into a posterior lateral strategy on one side of the spinal column, while the primary segments 60, 62 are inserted into a posterior lateral strategy on the other side of the spinal column. The primary and secondary elements then intertwine while in position within the intervertebral space. For example, in one embodiment, the notches in the assembled secondary elements form a tunnel through which the two assembled primary elements can be inserted from the opposite side. This method may mean that only two small incisions may be needed instead of a large incision. In another embodiment of the invention, a transverse implant 100 may be formed of two simple elongate elements 102, 104, which intersect in a central splice joint region. Various embodiments of implant 100 can be seen in Figures 10-15. Each elongated element has a vertebral surface with properties as discussed in the foregoing, and in the embodiment shown the elongated elements include projections 106. In certain embodiments alternatives, the projections 106 may be replaced by, or work in conjunction with, indentations and / or adhesive elements. Again, the elements may taper to various degrees, or the cross-sectional profile of the elements may be changed, depending on the specific requirements of the implant 100. Figure 10 shows a top view of the implant 100 inserted into an intervertebral space between the vertebrae 30 adjacent. The two elements intersect at an angle less than 90 degrees, although in alternative modes this angle can be increased up to 90 degrees or decreased down to 0 degrees. As shown in Figure 11, the elongate top element 102 and the bottom elongate element 104 are brought into contact with each other in a splice joint assembly, substantially in the center of the articular surface of each element. The splice joint includes a surface 108 configured in mount in the upper element 106, and a corresponding shaped surface 110 in the lower element 104. The surfaces 10 1 110 configured in the frame allow the upper and lower elongate elements 102, 104 to articulate, rotate, twist or rotate with respect to each other. As can be seen in Figure 10, the surfaces 10Í 110, configured in mount extend slightly beyond the width of the corresponding element, allowing in this way the two elements are twisted with respect to each other and increase or decrease the angle between the two elements. This can be advantageous by allowing the column to twist during mobility. In alternative embodiments, the surfaces 108, 110 configured in mount can be adjusted together with a more comfortable fit, thereby limiting or stopping the twisting of the two elements 102, 104 together. In alternative embodiments of the implant 100, the frame-like splice joint can be replaced by other appropriate splice joints, such as, but not limited to, a complementary male and female joint, two female or male joints and a complementary spacer, a joint of label, a pinned connection or any other appropriate splice elements. As in the above, this implant 100 can be inserted with a posterior lateral strategy into the intervertebral space although two small incisions, each on the patient's back on each side of the spine. In any of the embodiments of the invention mentioned in the foregoing or the following, the elongated elements may be replaced by spring elements, such as the spring-elongated element 120 of Figure 12, or the elongated arched element 130 shown in the Figure 13. Figure 12 shows an elongated element 120 type spring consisting of an arched or curved bar 124, a straight or flat bar 126, and connectors 128 that hold the two bars together at their outer ends. The configuration may result in element 120 providing a "ballestra" effect. Element 120 also includes a notch 122 for splicing with another elongate member 120. The use of elongated spring-like elements 120 can be advantageous by adding flexibility to the implant, and can, in certain embodiments, alleviate the need for articulation connections between the upper and lower elements, with the upper and lower elements in turn connected together in a fixed configuration. In this configuration, the required range of mobility of the implant can be provided by the spring mobility of the elongated elements themselves. In an alternative embodiment, the notch 122 can be replaced by any of the other splice joints mentioned in the foregoing. In some embodiments of the invention, only one, or some of the elongated elements in a given implant can be elongated spring-like elements 120, while in other embodiments, all of the elongated elements in an implant can be elongated spring-like elements 120. Figure 13 shows an elongated arched element 130 consisting of two end assemblies 134 which they support an arc in which a frame-type splice joint 132 is located. In alternative embodiments, the mount 132 can be replaced by any of the other joint connections or connections described in the foregoing. As with the spring-like elongate element 120 described above, the arcuate elongated element 130 can provide a "spring" effect which can be advantageous in either increasing the flexibility of the implant or replacing a joint joint between the upper and lower elements of the implant. In any of the embodiments of the invention mentioned in the foregoing or in the following, certain or all of the elongated elements may include a slotted portion on its articular surface. This may be advantageous in providing stability to the implant during use, and / or providing a means of aligning the elements during placement within the intervertebral space. The sides of the grooves may, in some embodiments, be tapered or rounded to allow room for axial rotation, or mobility of twisting, between the upper and lower elements of the implant. For example, the sides of the notch or frame joint joints can be angled or radiate to provide space and allow the elements to rotate horizontally with respect to the another, as shown by the angled notches 105 shown in Figure 10. One embodiment of an implant using elongated arched elements 130 with frame-like splice joints 132 can be seen in Figure 14. Here, the implant is configured in a manner similar to transverse implant 100 of two elements of Figures 9-10, with elongated elements 102, 104 replaced by a pair of arcuate elements 130. The ends 134 of the arcuate elongate elements 130 are securely integrated into the adjoining vertebrae to secure the implant in place. This integration of the ends of the arcuate elements can be achieved either surgically at the time of insertion or occur naturally with time due to subsidence caused by the pressure exerted on the implant by the spine. A top view of the transverse type implant with arched elongate elements 130 can be seen in Figure 15. One embodiment of an implant 140 using arcuate elongate elements 130 with a complementary male 142 and female 144 joint can be seen in Figure 16. In this configuration, two parallel arcuate elongate elements 130 replace the elongated elements 12, 14 of the embodiments of Figures 1-5. Using the configuration Parallel can allow the implant to be inserted into the intervertebral space using a single incision. Another embodiment of the invention can employ a scissors type design, with two elongated elements connected together by a pin-type connection. In this embodiment, the implant elements can be placed parallel during insertion to minimize the transverse profile of the implant during insertion, but then open after insertion to form a transverse type configuration. This embodiment can be used for a transverse configuration of two elements and a transverse configuration of four elements. The scissor-like configuration allows a single implant to deploy at any required angle from about 0 degrees to about 180 degrees between the elongated elements separated from the implant. A scissors type implant is also advantageous in that it allows a transverse implant to be inserted through a single incision in the patient's back, instead of requiring two incisions on each side of the spine as described above. In certain embodiments, the pin-type connection may include an elastic pin, or a union of another suitable flexible material, thereby allowing the pin-type connection to bend and thereby allow the relative articulation of the upper and lower elements around the location of the connection.

Figures 17A and 17B show a two-element scissors-like implant 150 in an insertion and deployed configuration, respectively. The implant 150 includes an elongate top element 154 and a bm elongate element 156. These two elements 154, 156 are connected by a pin 152 through the center of each element. Implant 150 can be inserted into the intervertebral space in its closed or insertion configuration, as shown in Figure 17A, where it has a small cross-sectional profile and, therefore, can minimize damage to the soft tissue during insertion. In placement within the intervertebral space, the implant 150 can be deployed in its open configuration, as shown in Figure 17B. In some embodiments of the invention, a specially designed insertion tool can be used to insert and deploy the implant 150, while in an alternative configuration, a standard surgical tool can be used to insert and deploy the implant 150. The implant elements 150 can be fabricated of two tapered elements, as described for the embodiments of Figures 1-11, while in an alternative embodiment, arcuate elongate elements may be used. In alternative configurations, the pin 152 can be replaced by any of the articulations of splices described in the foregoing, such as but not limited to, a complementary male and female joint, two female or male joints with a complementary spacer, a ball joint, a pair of frames or any other appropriate splice elements. For a scissor-type implant with one of these splice joints to be inserted through a single incision, there may be a need for an insertion tool to hold the pieces together during insertion. One embodiment of the invention that includes a four-arm type scissors-like implant 200 can be seen in Figures 18-22. In this embodiment, an upper scissor assembly 202 is spliced with a lower scissor assembly 204 through a splice joint 206. Upper and lower scissor assemblies 202 and lower 204 include two separate elongated elements that can be connected through a pivot, pin or other appropriate connection to form simple scissor assemblies that can rotate relative to each other around the center of each element. The splice joint 206 includes a ball joint. In alternative embodiments of the invention, other splice joints, such as those mentioned in the foregoing, may be employed in place of the patella 206.

The implant 200 may, in certain embodiments, include any feature, or group of features, discussed in the above-mentioned embodiments of the invention, including but not limited to, projections on the vertebral surfaces, indentations, adhesive sections, variable taper, elongate elements. curved or flat, and arched or spring elements. Figure 18 shows a side view of the implant 200 in a closed or insertion configuration. A corresponding top view of the closed configuration can be seen in Figure 19, looking down on the upper scissor assembly 202. Side and top views of the implant 200 in an open or unfolded configuration can be seen in Figures 20 and 21, respectively. Each of the upper scissors assembly 202 and the lower scissor assembly 204 includes two elongate elements that are rotatably connected about its central region. The portions of the elements that extend outside the central region of each element slide from the central longitudinal axis of the element, with the sliding of one element of each assembly reflecting the sliding of the other element of that assembly. As a result, the two elements of each assembly can rotate together in a closed configuration such that they form a single flat surface, as seen in Figures 18 and 19.

This produces a substantially flat vertebral surface for the upper scissor assembly 202 and the lower scissor assembly 204. In the deployment of the implant, the extended portions of each element of each assembly rotate around the rotating connection in the central region of that assembly while maintaining a substantially planar vertebral surface for each assembly, as shown in Figures 20 and 21. In an alternative embodiment of the invention, the scissors elements of each assembly can be configured in such a way that the extended portions of an element rotate below the extended portions of the other element of that assembly, thereby decreasing the transverse profile of the implant when insert In this embodiment, the scissors elements may include notches or other indentations, such that when a notch is deployed on the upper surface of the internal element it is mated with a notch in the lower surface of the upper element to allow the vertebral surfaces to be configured as a flat surface. In a further alternative embodiment, this notch may not be included. Figure 22 shows a side view of the implant 200 that articulates around its central splice joint 206. The complementary joint surfaces of the upper scissor assemblies 202 e lower 204 allow the upper 202 and lower 204 assemblies to move relative to each other with physiological mobility. In terms of vertebral mobility, the joint will allow rotation, flexion, extension, lateral bending and in some modalities, physiological translation. Some degrees of restriction to translation in one or more directions can be allowed depending on the configuration of the articulated surfaces. For example, tapering less an elongated element will limit the range of rotational mobility with respect to that element. The arrows 208 show an example of relative mobility of the upper scissor assemblies 202 and lower 204. Since the upper scissor assemblies 202 and lower 204 are separate pieces, an insertion or implantation tool may be necessary in some embodiments to allow upper and lower scissor assemblies 202 and 204 are inserted together as a single assembly. Figures 23-26 show a top, left lateral, right lateral and end view respectively of the implant 200 attached to a modality of an insertion tool 220. The insertion tool includes a first body 222 or main and a second body 224 of "substitute" support. The two bodies 222, 224 are connected by a tongue-and-groove interconnection 226, allowing the replacement support body 224 to slide along the length of the main body 222. In an alternative mode, guides Sliding or other suitable means for slidably connecting the main 222 and supporting 224 bodies can replace the tongue and groove interconnection 226. The insertion tool 220 can be releasably attached to the implant 200 through a set of four screws 228 which are inserted through the space of the threaded holes 234 in the two bodies 222, 224 of the insertion tool 220 and screwed into the screw holes at the distal ends of the four elongated elements of the implant 200. The screws 228 can be rotated through an Allen wrench, flat head or Phillips head screwdriver or some other appropriate means. In alternative embodiments, the screw connections between the insertion tool 220 and the implant 200 can be replaced by other appropriate releasable connections, such as, but not limited to, locks, latches, or magnetic connections. The distal ends of the main body 222 and the surrogate support body 224 have a wedge shaped protrusion 230 that abuts the recess in the sides of the implant 200 due to the taper of the articular surfaces of the upper and lower scissors elements 202 and lower. In alternative embodiments of the invention, the distal ends of the main body 222 and the substitute support body 224 may have flat ends, leaving a gap between the end of the insertion tool 220 and the inner portion of the implant 200. The main body 222 and the substitute support body 224 have two screw holes 234. The main body 222 is therefore connected through these two holes 234 to a distal end of an elongated element of the upper and lower scissors assembly 202 of the implant 200. In this way, the two halves of the implant 200 can be held together using only the main body 222 of the insertion tool 220. The other two distant ends of the elongate elements of the implant 200 can be attached to the substitute support body 224 of the insertion tool 220 in this manner further supporting the implant 200 and preventing the scissor assemblies of the implant 200 from opening. In this way, the insertion tool 220 and the implant 200 form a single assembly that can be used to store the implant 200 prior to insertion and to insert and deploy the implant 200 within the intervertebral space. A handle 232 is attached to the main body 222 of the insertion tool 220 to assist in the insertion of the implant 200. This handle 222 may be permanently attached to the insertion tool 220 or releasably attached to the tool. In alternative embodiments, the handle 222 may be capable of collapsing in the main body 222 when not It's in use. The handle 222 can be formed in a simple configuration, such as but not limited to, cylindrical, rectangular, or other polygonal configuration. In alternative embodiments, the handle 222 can be formed in a more ergonomically designed configuration, for example, holes or handles to assist the user's grasping of the handle 222. The implant 200 can be inserted into the intervertebral space through a single incision in the the back or side of the patient, using the posterior lateral or lateral strategies previously described. An insertion cannula configured in channel can be used to facilitate insertion of the implant 200 into the body, although in some embodiments, an insertion housing may not be necessary. Once correctly positioned within the intervertebral space, the insertion tool 220 can be used to deploy the implant 200 in its functional configuration before releasing the implant 200 and removing it. Figures 27-34 show the phases of deployment of the implant 200 after insertion into the intervertebral space by the insertion tool 220. Figure 27 shows a top view of the implant 200 and the insertion tool 220 in its fully connected insertion configuration. Here, the four screws 228 are in place, connecting the main body 222 and the body 224 replacing the implant 200. Once inserted correctly, the two screws 228 within the substitute support body 224 are removed, as shown in Figure 28. The substitute support body 224 can then be removed by sliding the body 224 to along the tongue-and-groove sliding connection that links the substitute support body 224 to the main body 222, as shown in Figure 29. A distracting wedge 238 can then slide in place along the sliding connection in the main body 222, as shown in Figure 30. This wedge-shaped body 238 may be a separate part with a wedge-shaped distal end set at a predetermined angle, depending on the required angle at which the implant 200 is to be deployed. Selecting a distracting wedge 238 with a different wedge angle at its distal end will result in a different deployment angle for the implant 200. In certain embodiments, the distracting wedge 238 may have a variable distal end, allowing one piece to be used to deploy the implant 200 at any required angle. In an alternative embodiment, the substitute support body 224 may have a wedge-shaped distal end, which allows it to act as the distracting wedge 238, thereby relieving the need for a separate part to be used to deploy the implant 200. For example, the substitute support body 224 may have a wedge configuration at the farthest end of the implant 200 throughout the insert. Then, the substitute support body 224 can be removed, as described in Figures 27-29, turned over and reinserted with the wedge end toward the implant 200. The distracting wedge 238 can then be advanced forward along the mechanism of Sliding to engage the elongate elements of the scissors implant 200, as shown in Figure 31. After the distracting wedge 238 has advanced as far as it can, thereby establishing the deployment angle of the elongated scissors-like elements. of the implant 200 at the angle predetermined by the angle and size of the wedge, the distracting wedge 238 can then be removed, as shown in Figure 32. In certain embodiments, the distracting wedge 238 can be configured to establish the upper and lower scissor assemblies. of the implant 200 at the same deployment angle, while in alternative configurations, the distracting wedge 238 can be configured for the upper and lower assemblies at different deployment angles having a different geometry for the portion of the distracting wedge 238 that brings each assembly into contact. The deployment of the implant 200 can be effected by other means, such as, but not limited to, mechanical means, springs, electrical means or other appropriate means. In certain embodiments, the implant may be constructed of a configuration memory material, such as a heat-dependent polymer. The implant can be fused in its deployed configuration and then formed in a collapsed state and cooled, such that while the temperature remains constant, the polymer maintains the collapsed configuration. The implant can then be inserted into the intervertebral space in its collapsed state, while the body heat will heat the implant and allow the polymer to expand back to its original deployed configuration. A heat dependent polymer could also be inserted into only a portion of the implant 200 to act as a spring, such that the implant 200 can be configured in a collapsed configuration for insertion, but once inserted, the body heat results in the expansion of the polymer element inserted between the elongated elements of one or both assemblies. This polymer element can then deploy the elongated elements of the implant and place them in place. In another example, a spring and safety arrangement could be included in the implant in such a way that in the release of a latch or pin, for example, by a cable or another connection through the main body 222 of the insertion tool, the spring forces open the scissor elements to the required angle. In these embodiments, there may be no need for a distracting wedge 238 or even a substitute support body 224. A piston-like element could also be used, in certain embodiments, to deploy the implant 200. The implant 200 can then be closed in its deployed configuration to prevent it from moving while being used. This can be achieved in one embodiment by screwing the screws 228 connecting the main body 222 to the implant 200 into closure holes 236 inserted in the upper and lower scissors elements of the implant 200, as shown in Figure 33. These holes 236 Closure may be threaded or non-threaded holes positioned within the implant 200 such that they are butted with the threaded holes in the elongated elements of the implant 200 when the required deployment angle is established. In some embodiments of the invention the implant 200 can be closed in its deployed position using another locking mechanism, such as, but not limited to, a pin, a latch or a lock mechanism. In further embodiments, there may be no locking mechanism for the implant 200, with the force exerted on the implant 200 by the surrounding vertebrae, or the use of projections, indentations and / or adhesive being sufficient to keep implant 200 in position. Once the screws 228 have been inserted into the implant 200 and no longer connect the implant 200 to the main body 222 of the insertion tool 220, the main body 222 can be removed, leaving the implant 200 in place within the intervertebral space, as shown in Figure 34. In modalities that include a channel or insertion cannula, this can also be removed at this time. FIGURE 35 shows a schematic perspective view of the main body 222 of an alternative insertion tool 220 with two segments of a four-segment "scissors" intervertebral implant 200. FIGURE 25 depicts the wedge-shaped end 230 of the main body 222 when it is connected to the recess in the implant 200 due to the tapering of the articular surfaces of the upper scissor elements 202 and lower 204. Also shown are the alignment trajectories of the screws 228, through the screw holes 234 in the main body 222 of the insertion tool 220 and in the threaded holes of the distal ends of the elongated elements of the implant 200. In alternative embodiments of the invention the deployment of the implant 200 can be achieved or aided by a twisting of at least a part of the tool 220 of insertion prior to its removal. For example, the wedge-shaped end 230 of a main body 222 could be twisted to deploy the upper and lower assemblies prior to removing the insertion tool 220. This may be advantageous in configurations where the distal ends of the elongate elements of the upper and lower assemblies must be deployed at different angles in the vertebrae, such that the distal ends of the lower assembly are not located directly below the distal ends of the vertebrae. upper assembly. A torque mobility of the insertion tool 220 could also be used to activate a deployment mechanism within the implant 200, such as a spring mechanism. FIGURES 36 and 37 show an alternative embodiment of a four-segment "scissors" intervertebral implant for insertion into an intervertebral space of a spinal column. This implant 300 is similar to that described above with respect to FIGS. 18-22, with an upper scissors assembly 314 and a lower scissor assembly 316, each including two elongated elements that rotate about their central location, and they are free to articulate around a central splicing joint once released from the insertion tool 310. The implant 300 is releasably connected to the insertion tool 310 by screws 312. The Insertion tool functions in a manner similar to that described with respect to FIGS. 23-35, but in this case without the need for a substitute support body to be attached to the implant during insertion. The front distant edges 302 of the implant 300, ie the leading edges of the implant 300 when inserted into the body, are bent to allow easier insertion into the body. The configuration of the leading edges 302, and the configuration of the complete transverse profile of the implant 300, can be established in certain embodiments to allow easier insertion into the body to limit damage to the soft tissue. These changes in geometry may include additional curvature of the leading and trailing edges, sharp points at the leading edges, or forming the implant with a bullet-shaped leading edge. The posterior edges 304 of two of the elongated elements of the implant 300 are chamfered. This can be advantageous by allowing a distracting wedge to contact and deploy the elongated elements without misalignment. In alternative embodiments, the posterior edges of the implant 300 can be designed to form a series of configurations, including, but not limited to, square, round, pointed or wedge configuration, depending on the specific configuration of the wedge distractor and the required deployment angle and configuration. As shown in FIGURE 37, the insertion tool 310 includes a distal end 318 configured in T for attachment to the upper scissor assemblies 314 and lower 316 of the implant 300. In alternative embodiments, the distal end 318 may take other forms, such as, but not limited to, a solid block, a V-shaped configuration, a U-shaped configuration, or an N-shaped configuration. FIGURE 38 shows a top view of the implant 300 attached to the insertion tool 310, the tool 310 of insert is attached to an ergonomic handle 320 to assist the user in guiding and manipulating insertion tool 310 and implant 300 during insertion. In certain embodiments, the handle 320 can accommodate an activator or other mechanism that can be connected through the insertion tool to a latch and spring, or other appropriate mechanism, to deploy the implant 300 without the need for a distractor wedge. FIGURE 39 shows implant 300 and insertion tool 310 inserted into an insert housing 330. The insert housing 330 includes an elongated, hollow body whose dimensions allow the implant 300 and the insertion tool 310 to pass therethrough. The housing 330 may have a shell configured substantially in "C" that is enclosed in three sides and open at least partially in a fourth side. The hollow in the partially open fourth side can be used as a slide to guide the insertion tool 310 and / or the implant 300 into the insert housing 330, and / or to allow body material to enter the housing 330 during the insertion to escape. The insert housing 330 also includes a spacer 332 and a front edge 334 configured as a wedge at its distal end. The spacer 332 is a substantially curved or pointed extension at the distal end of the insert housing 330 that can be used to bypass the vertebrae and facilitate insertion of the implant 300. The forward edge 334 formed in wedge may include a sharp edge , curved or pointed to facilitate the insertion of the insert housing 330 into the body. The spacer 332 can also assist in facilitating the insertion of the housing 330 in the body. The insertion housing 330 can be inserted into the body prior to the implant 300 and the attached insertion tool 310 is inserted into the housing 330, or in an alternative embodiment the implant 300 and the attached insertion tool 310 are first inserted into the housing 330 and then the whole apparatus is inserted into the body. As for the previous modalities, the implant 300 can be inserted through a posterior lateral strategy, anterior lateral or lateral. FIGURE 40 shows implant 300 and insertion tool 310 is inserted into insert housing 330. The housing 330 and the insertion tool 310 must be long enough to allow the end of the housing to extend beyond the skin of a patient, such that the handle 320 of the insertion tool 310 remains outside the body at all times. To deploy the implant 300 in its final extended configuration, a distracting wedge 336 may be passed along the insertion tool 310 and the insertion housing 330 to contact the chamfered end 304 of the implant 300. The distractor wedge 336 may then extend. the scissors elements at an angle determined by the size and geometry of the end of the distractor wedge 336 as shown in FIGURE 41. The distractor wedge 336 can then be removed, after which the screws 312 can be separated from the implant, using a Alien key or screwdriver, and the insertion tool 310 is removed. Finally, the housing 330 can be removed from the body, allowing the vertebrae to be set in place and leaving the implant deployed in position. A further embodiment of the invention can be seen in FIGS. 42A and 42B. In this embodiment, an implant 350 includes two elongate elements in a standard configuration scissors. The elongate top element 352 and the bottom elongate element 354 can be connected by a splice joint 356 and / or by a solid or flexible pin connection. FIGURE 42A shows a top view of implant 350 in an implantation configuration. In this configuration, the elongated elements 352,354 are rotated in such a way that the leading edge of the implant 350 forms the smallest profile possible during insertion. In alternative embodiments of the invention, the leading edges may be curved, scored or otherwise configured to further reduce the transverse profile of the leading edge and thereby facilitate insertion of the implant 350. In additional alternative embodiments, the extended arms of the elements elongated can be hinged, such that the arms fold together during insertion of implant 350 and only extend and close in a deployed configuration after insertion. These hinged arms can be applied to any of the previously mentioned modalities to facilitate insertion of the implant. Additional embodiments of the invention can be seen in FIGURES 43A and 43B. In this embodiment, a device 357 includes an implant 358 having two parallel elongate elements and an insertion tool 359. The implant 358 can have any design or configuration as described herein, including a scissors-like configuration. The insertion tool 359 includes slotted connections 361 that allow the ends of the elongated upper and lower elements of the implant 358 to move up and down with respect to each other. As a result, the implant 358 can be rotated in such a way that the leading edges of the upper and lower elongate elements of the implant 358 rest against each other, thus forming a substantially wedge-shaped profile with a reduced cross section at the edge front to facilitate insertion. By sliding the screws, bolts or other connecting elements connecting the implant 357 to the insertion tool 359, together with the slotted connections 361, the implant 357 can then be returned to its neutral or parallel configuration prior to being deployed in an open configuration. Alternatively, the implant 357 can be returned to its parallel configuration while it is inserted into the patient, prior to being released by the insertion tool 359. For example, the leading edges of the elongate elements can be manually placed in the wedge-shaped profile for insertion of the implant and automatically returned to the parallel configuration by the force of the tissue and / or the action of the vertebrae on the elongated elements during the insertion. In one embodiment, the 361 connections slotted into the insertion tool 359 allows the elongate members to move relative and freely in the vertical direction, while preventing the implant 358 from deploying in the open configuration. FIGURE 43B shows the implant 358 connected to an alternative insertion tool 363. In this configuration, the upper and lower elements of the insertion tool 363 can rotate about an axis 365, such that puncturing the ends of the insertion tool 363 together forces the implant 358 into an insertion configuration, with the edges of the elongate upper and lower elements of the implant 358 resting against each other, thus forming a substantially wedge-shaped profile with a reduced cross section at the leading edge to facilitate insertion. At or during insertion, the implant 358 can be rotated in its neutral configuration by rotating the upper and lower elements of the return insertion tool 363 in a parallel configuration. Alternatively, the insertion tool 363, and by extension of the implant, can be deflected in the parallel configuration by removing the pinching force. Additionally, the insertion tools 359, 363 may include similar structure and operate similarly as the insertion tools previously described. Additionally, the various characteristics of the implants described with respect to FIGS. 42 and 43 can be combined to reduce the vertical dimension and the horizontal dimension of the cross section of the leading edge of the implant. In alternative embodiments, the insertion tool may include a number of alternative mechanisms to allow the implant to be placed in an insertion configuration configured as a wedge and a deployed configuration. These mechanisms may include, but are not limited to, a screw, a cable, a telescope, a spring, a pump, a plug, or other appropriate mechanism. In some embodiments, this mechanism can move the implant 358 manually, while in other embodiments a device could be used to move the implant 358 automatically in a start instruction of a user. In certain embodiments, the insertion tool may not need to actively force the implant in the neutral or open configuration, but the implant 358 may be moved, for example, from an insertion configuration to a neutral configuration by the force of the superior and inferior vertebrae alone, either while the implant 358 is inserted or after the insertion tool is removed. The implants described above can also assume many other configurations other than those described in the above. For example, the implant may include upper and / or lower assemblies configured in such forms as, but not limited to, A, H, I, K, M, N, T, W, Y, and Z. These assemblies may be fixed, or they can be folded during insertion and deployment in their final configuration after insertion in the intervertebral space. Alternative embodiments of the invention, which incorporate a number of different configurations, can be seen in FIGURES 44A-44F. FIGURE 44A shows a "Z" shaped assembly 360, FIGURE 44B shows an "H" shaped assembly 370, FIGURE 44C shows an assembly "T" configured 380, FIGURE 44D shows an assembly 390 configured in "Y" ", FIGURE 44E shows an assembly 400 configured in" A ", and FIGURE 44F shows an assembly 410 configured in" W ". Each of these embodiments shows top views of an implant that includes a splice joint point 362 at or near the central portion of the assembly. The splice joint 362 can include any of the methods of splicing the upper and lower assemblies of an implant described in the exemplary embodiments mentioned previously. The assemblies also include 364 connections with bolt or hinge, or other appropriate connection mechanisms, to allow the elongated arms of the implants to bend to provide a Minimum cross section profile during insertion. These arms can then be deployed in an operating configuration as described in the previously mentioned embodiments. In certain embodiments, such as the assembly 400 configured in "A" of FIGURE 44E, slots 402, or other appropriate hinge members or channels, may be included to facilitate folding of the elongated members into a minimum section profile for insertion. In further embodiments of the invention, the upper and lower implant assemblies can be configured such that they can be inserted into the body in an insertion configuration with a minimum cross-sectional profile, and then deployed in an operating configuration, where the area of the vertebral contact surface increases with deployment. This can expand and / or redistribute the points of contact between an implant and a vertebra. FIGS. 45A and 45B show one embodiment of an implant with the elongated arms extending out of the splice joint region and include a number of rotating fingers with a truss between each finger. In its insertion configuration, as shown in FIGURE 45A, implant 420 includes a number of fingers 424 that are folded together and connected at joint point 424 splice. In the deployment of the implant 420, the fingers 422 rotate externally and extend a framework material 426 that forms a tight or hard surface between each finger 422 and thus extends the surface area contacting a vertebra. The framework 426 can be made of materials such as, but not limited to, an elastic material, a fibrous material or a hard corrugated material. FIGURES 46A and 46B show another embodiment of an implant with a surface area that can be increased in deployment. In this configuration, an implant 430 includes a first substantially semicircular element 432 with a joint 434 at the radial center of the semicircular element. A second substantially semicircular element 436 is rotatably coupled to the first semicircular element 432, such that it can rotate under the first semicircular element 432 or rotate out and from a substantially circular surface with the first semicircular element 432. In one embodiment, the second semicircular element may be configured to be substantially flush with the first semicircular element in the deployment, such that a substantially planar circular contact surface is formed. FIGURE 46A shows implant 430 in its minimized configuration, to be implanted in the intervertebral space. FIGURE 46B shows the second substantially semicircular element 436 deployed for maximize the surface area of the implant 430. The embodiments of FIGS. 45A-B and 46A-B can be advantageous in helping to distribute the load over a maximal area of the vertebrae, thereby minimizing damage to a vertebra through the tension caused by the presence of the implant. This increase in the surface area in the deployment can also be achieved in other embodiments of the invention, where one surface is placed under another surface during insertion, such as in certain scissors-like embodiments. In an alternative embodiment, a heat-dependent polymer, which expands at a certain temperature, can be used to facilitate the increase in the surface area of the implant. In alternative embodiments of the invention, the splice joint region may be capable of being changed when it is converted from an insert configuration to a deployed configuration. This change in the splice joint region may include an increase in the surface area of the splice region and / or a change in the location of the splice joint in the deployed configuration. These changes in size and / or location of the splice joint may be advantageous in limiting the profile of the implant during insertion, thereby limiting damage to the surrounding tissue during insertion. Increase the size of the region of Splicing joint deployment may also be advantageous in distributing the load between the upper and lower implant assemblies, and may also allow a wider variety of sizes and shapes of splice joints available, depending on the requirements of the specific implant. Changing the location of the splice joint for deployment can also be advantageous by allowing the splice joint to move from the center of gravity of an unfolded implant after the elongate elements extend, especially in configurations where the center of gravity of the implant deployed does not conform to the center of any elongated element of the implant. In certain embodiments of the invention, the splice joint may include one or more separate, distinct elements that may be attached to at least one elongated member of a top or bottom assembly by a connection that includes, but is not limited to, bolt , grooved, threaded, magnetic or other appropriate connection mechanism. This connection mechanism may allow the splice joint to change position in the implant from one insertion location to a deployment location. Exemplary embodiments of implants with expandable and / or movable splice joints can be seen in FIGURES 47A-C and 48A-B. FIGURES 47A-C show an implant 450 with a splice joint including a first splice joint member 454 and a second splice joint member 456. The splice joint is connected to an elongate element 452 of the implant 450 through a slotted connection 458. In FIGURE 47A, the second splice joint member 456 is positioned within the first splice joint member 454 to minimize the transverse profile of the implant 450 for insertion into an intervertebral space. Once inserted in the proper position within the intervertebral space, the implant 450 can be deployed. This may include opening the splice joint by rotating or otherwise moving the second splice joint member 456 out of the first splice joint member 454, as shown in FIGURE 47B. In certain embodiments, the slotted connection 458 can be used to join the splice joint to the elongated element 452, so that after, or possibly before, expanding the splice joint, the center of the joint can move to a new location, of deployment. The placement of the splice joint in a final, deployment position can be seen in FIGURE 47C. Other means for expanding the articulation surface include those described with respect to FIGS. 45A-B. FIGURES 48A-B show a modality of a implant 460, where the splicing joint 466 can be moved from a position for insertion of the implant 460 to a second position for deployment of the implant 460. FIGURE 48A shows the implant 460 in its insertion configuration, with the cross-sectional profile of the implant 460 minimized to facilitate insertion into the intervertebral space. The implant 460 includes an upper assembly 462 and a lower assembly 464 which in their unfolded configuration contact each other at the location of the splice joint 466. In the insert configuration, the splice configuration moves beyond the center of gravity of the implant 460 to decrease the profile of the implant 460. This movement can be facilitated by a slotted slide guide 468, or other suitable means. In alternative embodiments, a rotary mechanism can be used to move the joint joint from one configuration to another. Once inserted in the intervertebral space, implant 460 is established in its deployed configuration. This includes moving the splicing joint 466 along its slotted guide 468 to the center of gravity of the implant 460. In certain embodiments of the invention, the center of gravity does not need to be in the center of a specific elongate element, but can be on or near a distant or side edge of an element elongate. The establishment of the splice joint 466 to its deployed configuration can, in certain embodiments, be enabled by the insertion tool or an appropriate surgical tool. In alternative embodiments, springs or other appropriate mechanisms may be included to deflect the splice joint to its deployed position, such that in deployment, the splice joint is automatically forced into its deployed position and / or configuration. In other embodiments, the splice joint may include configuration memory materials, such as a heat-dependent polymer, which may expand after insertion to facilitate the increase in the size of the splice joint or assist in moving the joint. splice from an insert configuration to a deployment configuration. For example, a material that expands upon heating to body temperature can be placed in the slot 468 of the implant 460 shown in FIGS. 48A-B, to push the splice joint 466 in its deployment configuration after insertion. In various embodiments of the invention (see for example, FIGURES 18 and 19) the implant may have overall dimensions as follows. The height of the implant, H, can be approximately 4 millimeters (mm) approximately 20 mm, and preferably approximately 7 mm to about 18 mm, and more preferably from about 9 mm to about 16 mm. The width of the implant, W, can be from about 5 mm to about 20 mm, and preferably from about 6 mm to about 16 mm, and more preferably from about 8 mm to about 12 mm. The length of the implant can be from about 15 mm to about 60 mm, and preferably from about 24 mm to about 45 mm, and most preferably from about 28 mm to about 38 mm. In one embodiment of the invention, the implant may have a height of approximately 12 mm, a width of approximately 10 mm, and a length of approximately 43 mm, or any other dimensions within the ranges listed. These dimensions can be varied depending on the location in which the implant is placed within an intervertebral space, the size, conformation and physiology of the patient, and the mechanical requirements of the implant to be inserted. In any of the preceding claims, the intervertebral implant, articulation elements, and / or insertion tool may be made of a material or materials including, but not limited to, stainless steel, aluminum, tantalum, gold, titanium, ceramics, chrome, cobalt, nitinol, metal / ceramic matrices, polytetrafluoroethylene (PTFE), thermoplastic polyurethane (TPU); ethylene vinyl acetate (EVA); thermoplastic polyether block amides; thermoplastic polyester elastomers, nylons, silicones; polyethylenes; polyamides, and polyetheretherketone (PEEK). The implant, articulation elements and insertion tool can be processed, emptied, molded, extruded or fabricated in any appropriate manner. In certain embodiments each element may be constructed of the same material, but in other different material embodiments may be used for different elements of the invention, and multiple materials may be used to construct the device. The invention can be represented in other specific forms without departing from the spirit or essential characteristics thereof. The foregoing modalities, therefore, should be considered in all illustrative rather than limiting directions of the invention described herein. The scope of the invention is thus indicated by the appended claims, rather than by the foregoing description, and all changes that come within the meaning and equivalence range of the claims are intended to be encompassed therein.

Claims

CLAIMS 1. An intervertebral implant, characterized in that it comprises: an upper assembly comprising at least two elongated elements; and a lower assembly comprising at least two elongated elements; wherein the upper assembly is adapted to articulate relative to the lower assembly.
2. The implant in accordance with the claim 1, characterized in that at least the two elongated elements of at least one of the upper assembly and the lower assembly intersect to form an X-configuration.
3. The implant according to the claim 1, characterized in that at least the two elongated elements of at least one of the upper assembly and the lower assembly are intertwined to form a conformation selected from the group consisting of A, H, I, K, M, N, T, V , W, Y, and Z.
The implant according to claim 1, characterized in that at least one of the elongated elements comprises a fold.
5. The implant according to claim 1, characterized in that the implant comprises a material selected from the group consisting of stainless steel, aluminum, tantalum, gold, titanium, ceramics, chrome, cobalt, nitinol, metal / ceramic matrices, polytetrafluoroethylene, thermoplastic polyurethane; ethylene vinyl acetate; thermoplastic polyether block amides; thermoplastic polyester elastomers, nylons, silicones; polyethylenes; polyamides and polyetheretherketone.
The implant according to claim 1, characterized in that the elongated elements define a space therebetween to allow a limited range of mobility between the elongated elements and an interlaced arrangement.
The implant according to claim 1, characterized in that at least the two elongated elements of at least one of the upper assembly and the lower assembly are detachable between a closed position and an open position.
The implant according to claim 7, characterized in that the deployment is effected by a shaping memory material.
The implant according to claim 7, characterized in that at least the two elongated elements comprise an I-configuration in the closed position.
10. The implant in accordance with claim 7, characterized in that at least the two elongate elements comprise at least one of an X configuration and a Y configuration in the open position.
The implant according to claim 7, characterized in that at least the two elongate elements are movable through a predetermined angular range between the closed position and the open position.
The implant according to claim 11, characterized in that the predetermined angular range comprises a value greater than 0 degrees and less than 180 degrees.
The implant according to claim 7, characterized in that at least the two elongated elements are secured by a pivot.
The implant according to claim 7, further characterized in that it comprises a closing mechanism to prevent relative movement between the elongated elements.
The implant according to claim 14, characterized in that the closing mechanism comprises a shaping memory material.
16. The implant according to claim 1, characterized in that at least one of the upper assembly and lower assembly adapts to engage an adjacent vertebral surface.
The implant according to claim 1, further characterized by a joint region disposed in each of the upper assembly and the lower assembly.
The implant according to claim 17, characterized in that the articulation regions comprise a protrusion disposed in one of the upper and lower assembly and a splice recess disposed in the other assembly., the protuberance and the hollow at least partially in contact.
The implant according to claim 17, characterized in that the articulation regions are selected from the group consisting of a patella configuration, a male-to-female configuration, arcuate splice surfaces and corresponding mounts.
The implant according to claim 1, characterized in that at least one of the elongated elements tapers along the length thereof.
The implant according to claim 1, characterized in that at least one of the elongate elements defines at least one opening to allow bone growth thereon.
22. The implant according to claim 1, characterized in that the implant comprises a spacer arranged between the upper assembly and the lower assembly.
23. An intervertebral implant, characterized in that it comprises: an upper assembly comprising at least one elongated element; and a lower assembly comprising at least one elongated element intertwined with the upper assembly; wherein the upper assembly is adapted to allow a limited range of mobility between the intertwined elements.
24. An intervertebral implant, characterized in that it comprises: an upper assembly comprising at least two elements, at least the two configurable elements for varying a size of a vertebral contact surface area of the upper assembly; and a lower assembly supporting the upper assembly, the lower assembly comprises at least two elements, at least the two configurable elements for varying a size of a vertebral contact surface of the lower assembly.
25. The implant in accordance with claim 17, characterized in that the articulation regions are expandable to increase a carrier contact surface between the upper assembly and the lower assembly.
26. An intervertebral implant, characterized in that it comprises: an upper assembly; a lower assembly coupled to the upper assembly through splice joint regions, wherein the hinge regions comprise expandable carrier surfaces.